Pseudarthrosis is what medicine means when a broken bone fails to heal, leading to the development of a false joint. It usually causes severe pain and limitations in mobility. The therapy depends on the exact form of the pseudarthrosis, good prognosis can always be given.
What is nonunion?
The term pseudarthrosis is made up of the Greek words “pseudes” and “arthros” and means something like “wrong joint”. The terms sham joint, pseudo joint or false joint are used synonymously with pseudarthrosis. See whicheverhealth for HHS Meanings.
The disease is diagnosed when there is no healing six months after a broken bone or the surgical procedure of osteotomy. Before that, after four to six months without adequate healing, one speaks of delayed fracture healing.
The doctor differentiates between vital non -union and non- vital non- union. In the latter, the fracture is unstable, poorly supplied with blood, and the surrounding tissue is inflamed or dead. In thevitalPseudarthrosis is because the tissue is still well supplied with blood, but the fracture is also unstable.
Pseudarthrosis is caused by insufficient healing of broken bones.
Fractures in the shafts of long tubular bones, such as the lower and upper thighs and the upper and lower arm, are particularly susceptible to pseudarthrosis. The false joint often occurs as a complication of a scaphoid fracture. Specifically, a distinction must be made between mechanical and morbid causes of pseudarthrosis.
Mechanical causes are the shifting of soft tissues into the fracture region, the shifting of the fracture ends against each other, inadequate treatment of the fracture with insufficient compression of the wound and premature mobilization of the fracture.
Morbid causes include excessive, but improper, bone healing, callus, tissue loss from inadequate patient care or insufficient blood supply to the wound, infections, and systemic diseases. In particular, patients with diabetes mellitus or arterial diseases are often affected. Rarely, the risk of disease is congenital.
Symptoms, Ailments & Signs
Pseudoarthrosis can develop if the fracture sites do not heal sufficiently after a bone fracture. In such a case there is a discontinuity, a disturbance in the healing tissue. Shaft bones such as the thigh, ulna, radius and upper arm are very susceptible to this.
Various characteristics point to a pseudoarthrosis. If a bone heals relatively slowly after a fracture, this can be the first sign. If healing does not start within six months, it can be referred to as pseudoarthrosis. The disease usually develops gradually. The symptoms therefore continue to be delayed.
Pain is one of the first signs of pseudoarthrosis. At the beginning of the disease, these often only occur under stress. Chronic pain can develop later with rest. Restricted movement and a reduction in strength are also typical of this clinical picture. Conversely, hypermobility and instability can also be signs of pseudoarthrosis.
Because the stability of the bone is sometimes greatly reduced, an axial deviation of the bone can develop. This is partially visible. In addition to the symptoms mentioned, reddening and swelling in the affected area provide further indications of the development of the disease. Water retention in the area of the broken bone is not uncommon.
In a septic course, systemic symptoms continue to make themselves felt. Since pathogens are involved in this development, fever and deterioration in general condition can occur.
Diagnosis & History
Pseudarthrosis is diagnosed when six months after the bone fracture has not healed. This can and must be determined with imaging procedures. X-ray diagnostics often show pseudarthrosis gaps and sclerosis of the surrounding tissue.
Signs of the disease are also persistent movement and functional restrictions or excessive mobility of the affected body parts and persistent pain. It is also important that the diagnosis clearly establishes whether the patient has a vital or non-viable pseudarthrosis, because the therapy is initiated accordingly.
The course and prognosis depend on how far the pseudarthrosis has progressed. In the early stages, there are good chances of success. But the more the surrounding tissue is affected and the further the hardening has spread, the more difficult the therapy becomes.
If the doctor’s instructions are strictly followed, the chances that the pseudarthrosis will heal without subsequent surgery are not bad. A plaster cast must be worn for a full six weeks. If the person affected is diabetic, it is important that they are well adjusted to their medication or injections in order not to delay the healing even further. Smoking is particularly harmful as everything should be done to promote good blood flow to the affected areas.
Some patients find it helpful to cool the affected area to reduce pain. Cooling elements wrapped with a household towel or a thin towel can be used for this purpose. Others suffering from pseudarthrosis need heat, such as cherry pit bags that are first warmed up in the oven. Never place the hot water bottles or the cooling elements directly on bare skin. However, most of those affected are forced to take painkillers in order to get a handle on the long healing process of the pseudarthrosis.
What the patient suffering from non-union needs above all is patience. The disease is usually curable, but it would be misleading to orientate oneself to the regular healing process of the previous fracture.
When should you go to the doctor?
If symptoms such as bone pain, bone malformations or movement disorders occur, pseudoarthrosis may be the underlying cause. A doctor should be consulted when symptoms first appear. If they don’t go away on their own, it’s best to see an orthopedist.
The doctor can determine the pseudoarthrosis using an X-ray examination and start treatment. People who have severe pain or restrictions in everyday life due to another bone, joint or muscle disease should inform the responsible doctor. Pseudoarthrosis also occurs after broken bones or complicated operations.
Patients at risk should inform the doctor about pain, especially if it occurs in connection with an accident or a surgical procedure. The bone condition is treated by an orthopedist or a bone disease specialist. Other contact points are the physiotherapist and a sports physician. In addition, the disease usually requires further surgical intervention. Further follow-up checks are necessary after the treatment. In addition, the doctor should be consulted in the event of unusual symptoms.
Treatment & Therapy
The treatment of nonunion depends on its exact form and the severity of the disease.
Vital pseudarthrosis, in which an adequate blood supply has been identified and which shows sufficient fibrosis and ossification for good healing, requires light forms of therapy. The focus is on improving the mechanical framework of the fracture. This is achieved by osteosynthetic measures, for example with a ring fixator.
Avital pseudarthrosis requires far-reaching and complex therapeutic measures. Since this form of the disease no longer has sufficient healing powers, it requires far more severe medical measures than the vital pseudarthrosis. Osteosynthesis is not sufficient, but is used for further stabilization.
In addition, infected bone areas must be surgically removed and bone reconstruction initiated at the same time. The surgical insertion of bone tissue into the fracture gap can help. Some doctors also prescribe bone morphogenetic proteins for their patients to stimulate regeneration. Especially the medication with BMP2 and BMP7 was able to achieve good results.
However, the treatment of pseudarthrosis starts with the follow-up check of broken bones, because this allows the healing process to be observed. At the first signs of pseudarthrosis, action can be taken quickly and dangerous complications can be prevented. Patients at risk, in particular, should keep in regular contact with their attending physician after a broken bone. Furthermore, patients with a fracture should follow the measures prescribed for them and not move the fracture too early or remove the cast.
The follow-up treatment of pseudoarthrosis depends on the underlying diseases and the effects that have favored the pseudoarthrosis. It is important to avoid breaking bones, as complications in the form of renewed pseudoarthrosis can occur again and again during healing. If there is a vitamin D and/or calcium deficiency, it is necessary for this to be permanently remedied.
This may require a continuous increase in the intake of calcium and vitamin D from dietary supplements. Calcium and vitamin D levels should be checked regularly in the blood when such therapy with dietary supplements is carried out. This can be done at the family doctor. If reduced blood flow was the cause of the pseudoarthrosis, permanent treatment with bone morphogenetic proteins or with blood-thinning medication (Macumar) may be necessary.
If infectious diseases, arterial occlusive diseases or diabetes were the cause of the development of the pseudoarthrosis, it is important to treat them permanently even after they have healed in order to prevent the pseudoarthrosis from developing again. In the case of a hypertrophic pseudoarthrosis without other causes, no special follow-up care is possible after healing. In addition, the tendency to fractures that do not heal properly persists in all types of pseudoarthrosis despite proper follow-up care.
You can do that yourself
Pseudoarthrosis must be diagnosed and treated by a doctor. Depending on the severity of the disease, the patient himself can take some measures to promote recovery and avoid complications.
Basically, the medical recommendations regarding physical exercise and rest should be followed. In the case of broken bones in particular, sufficient rest is important in order to avoid the development of pseudoarthrosis or to support its healing process. In everyday life, aids such as crutches or a wheelchair can make moving around easier. Those affected can also help themselves by having various changes made in the household, for example the installation of stairs suitable for the disabled.
At the same time, contact with other affected people is recommended. Since people with pseudoarthrosis are restricted in their ability to move, physiotherapy or special yoga and aerobic programs are available. In addition, you should always pay attention to a healthy diet. The doctor will recommend a low-fat, low-salt diet rich in vitamins and minerals. If, despite these measures, the symptoms increase or other problems occur, the doctor must be informed so that the treatment can be adjusted.